MISS Ileha M Clark

NPI #1619531936 in Macon, Georgia

Provider Information

NPI Number: 1619531936
Entity Type: Individual
Name: MISS Ileha M Clark
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Program of All-Inclusive Care for the Elderly (PACE) Provider Organization
Enumeration Date: Apr 23, 2019
Last Updated: May 3, 2019

Practice Location

Address: 152 NEW ST STE 103M
City: Macon
State: Georgia
ZIP Code: 31201-7304
Phone: (478) 508-7124

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Chore Provider	372500000X
Program of All-Inclusive Care for the Elderly (PACE) Provider Organization	251T00000X	Primary

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